Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 44, Issue 6
Displaying 1-12 of 12 articles from this issue
  • Yoshiko OKIKAWA, Yasuo TAKIMOTO, Masaaki NODA, Jyun IMAGAWA, Yuta KATA ...
    2003 Volume 44 Issue 6 Pages 368-374
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    Thalidomide as a single agent (200-400 mg/day) was administered in fourteen cases of refractory myeloma, from March 2001 till February 2002. The median age was 71 years (range 58 to 85 years), and the efficacy of thalidomide was observed in cases receiving treatment for at least three consecutive months. Response was evaluated in February 2002, according to the criteria for assessment of response described by Kakimoto et al. At the time of evaluation, two cases were in the PR2 state, one in PR3, two were stable, and three were PD. Evaluation of the response was not possible in six cases in whom treatment had to be discontinued due to intolerable side effects. The response to thalidomide was variable, with some cases responding well even to a low dose (200 mg/day) while a few others showed an early relapse due to the refractory nature of the disease in its response to the drug. The efficacy of treatment seemed to be correlated with the maturation pattern of myeloma cells. Side effects included neurological complications like somnolence, physiological symptoms such as constipation and so on, etc but all were relieved with symptomatic treatment. The drug was well tolerated in geriatric patients. Neutropenia was a dose limiting factor with half of the cases (7/14) presenting with severe neutropenia (grade 3-4), but a response was observed in all of them on administration of G-CSF. Thromboembolism occurred in two cases, the cause of which is not clear. These results suggest that thalidomide is a well tolerated drug and can be considered as a mainstay in the therapy of refractory myeloma.
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  • Tomohisa YOKOYAMA, Keisuke MIYAZAWA, Kazuyo SUNAGA, Shigeru SUZUKI, Ch ...
    2003 Volume 44 Issue 6 Pages 375-380
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A 58-year-old male started passing dark brown colored urine in January 2002. An annual medical examination in the same month revealed a mild anemia and an increased serum LDH level. Because of the instability of the data of his peripheral red cell count and hemoglobin concentration as measuring with a blood cell auto-analyzer, and also the hemolytic findings in a test tube at room temperature (25°C), he was referred to our hospital. Laboratory data revealed Hb 11.2 g/dl, reticulocytes 73.1‰ (233,000/μl), indirect-bilirubin 2.8 mg/dl, LDH 757 U/l, and hemosiderinuria, suggesting some intravascular hemolysis. The cold agglutinin titer was >1,024, direct and indirect Coombs tests were both positive, and the Donath-Landsteiner antibody (D-L antibody) was initially assessed as false positive because of a high titer of cold agglutinin. He was finally diagnosed as having a cold agglutinin disease (CAD) with anti-I autoantibody. Serologic tests for syphilis and mycoplasma, and various virus tests were all negatives. After avoiding cold exposure, his symptoms, including hemoglobinuria, disappeared. However, during 9 months follow-up, he still showed a high titer of cold agglutinin. This case suggests that CAD should be considered when peripheral blood cell count data are unstable as assessed by a blood cell auto-analyzer.
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  • Toshio KATAYAMA, Masami KAMIYA, Sadayori HOSHINA, Hidekazu MASUOKA, Ka ...
    2003 Volume 44 Issue 6 Pages 381-385
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    We report on a 58-year-old male diagnosed as having primary myelofibrosis with thrombocytopenia, who died of fatal septic shock and rhabdomyolysis after platelet concentrates (PCs) transfusion. The initial diagnosis of primary myelofibrosis was established by splenomegaly, leukoerythroblastosis and bone marrow fibrosis. PCs were transfused because of thrombocytopenia with marked bleeding tendency. Soon after the PCs transfusion in March 2000, he had attacks of chest pain, back pain and myalgia, then went into shock and died of unknown causes. PCs were suspected as being the cause of death, because Streptococcus pneumoniae was found in the culture of PCs in the WBC-reduction in-line filter and fresh frozen plasma from the same donor preserved in the Japan Red Cross Center. Rhabdomyolysis, neutrophil infiltration and phagocytosed bacteria were found from the autopsy materials, which were identified by DNA analysis as the same species found in the PCs. PCs are kept at room temperature because platelet function is lost in the cold. When PCs are contaminated with bacteria, marked multiplication induces fatal bacteremia. This is a rare report in Japan of fatal septic shock caused by PCs with bacterial contamination. We must pay strict attention to bacterial contamination in blood components.
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  • Katsuki SUGIYAMA, Noriko USUI, Osamu ASAI, Takeshi SAITO, Shingo YANO, ...
    2003 Volume 44 Issue 6 Pages 386-390
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A 29-year-old man was referred to our hospital with leukocytosis on March 7th, 2002. The white blood cell count was 132.9×103l with 42.0% blast cells. We diagnosed Philadelphia chromosome-positive chronic myelogenous leukemia (CML) in a blast crisis and started imatinib mesylate therapy at a dose of 800 mg/day on March 9th, 2002. The patient's peripheral blood blasts had disappeared by March 22nd, 2002, and the percentage of blasts in the bone marrow was 0.6% on May 2nd, 2002. The patient achieved a complete cytogenetic response on May 13th, 2002, and underwent allogeneic peripheral blood stem cell transplantation from his HLA-identical sibling donor on May 30th, 2002. Although adverse reactions such as grade 3/4 of hematological events (leukopenia, anemia, thrombocytopenia and neutropenia) and grade 1/2 of non-hematological events (hyperbilirubinemia, dermatitis and edema) were observed, these adverse reactions were clinically managed. This case suggested the usefulness of imatinib mesylate in the management of the CML-associated blast crisis.
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  • Naoto TAKAHASHI, Ikuo MIURA, Masaaki KUME, Yoshinari KAWABATA, Makoto ...
    2003 Volume 44 Issue 6 Pages 391-395
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    We report on a 61-year-old woman with chronic myeloid leukemia (CML) who developed a hemolytic uremic syndrome (HUS)-like episode following nonmyeloablative allogeneic hematopoietic stem cell transplantation. Macrohematuria, hypertension, hemolytic anemia with red cell fragmentation, thrombocytopenia, and progressive renal insufficiency were observed after thawed peripheral blood stem cell (PBSC) infusion. Although transient systemic hemolysis is known to occur during dimethylsulfoxide (DMSO)-cryopreserved stem cell infusion, HUS caused by DMSO has not been described in the literature. We speculate that one of the triggers of the HUS-like episode could have been renal microangiopathy caused by the long-term administration of interferon-α before the stem cell transplantation.
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  • Naoki TAKEZAKO, Tateki SHIKAI, Akira TANIMURA, Chiho INOKUCHI, Noboru ...
    2003 Volume 44 Issue 6 Pages 396-400
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    Various cases of myelodysplastic syndrome (MDS) with diverse immunological disorders have been reported by many investigators. In this case report, we present a 70-year-old woman who had been diagnosed as having MDS and liver cirrhosis (LC) type C for 20 months, and who finally developed autoimmune phenomena against autologous blood cells. She was admitted to our hospital in order to evaluate her advanced anemia, thrombocytopenia and fatigue. The laboratory data at admission were as follows: hemoglobin 5.3g/dl, red blood cell count 109×104l, white blood cell count 1,760/μl, platelet count 4.3×104l and reticulocyte count 1.3%. The direct Coombs test was positive. In addition, anti-platelet antibody was positive, using the MPHA method. With these results, Evans syndrome secondary to MDS or LC was diagnosed. The mechanisms for the development of immunological disorders in patients with MDS or LC have not been fully elucidated. To our knowledge, this patient is one of the rare cases with MDS and Evans syndrome reported in the literature. During the generation process of autoantibodies, the role of HCV antigen in the pathogenesis of Evans syndrome was of interest in this patient.
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  • Takashi ASHIDA, Yasuhiro MAEDA, Akihisa KANAMARU, Tatsuo ICHINOHE, Tak ...
    2003 Volume 44 Issue 6 Pages 407-413
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    The status of reduced-intensity stem cell transplantation (RIST) in the Kinki area was investigated by questionnaires. We sent out questionnaires to 72 institutions and received 51 replies (72.2%). RIST was performed in 16 institutions (31.4%). A total of 91 cases were included of whom approximately 70% were non-remission or advanced hematological malignancies. Various conditioning regimens were used for RIST, most often consisiting of fludarabine, busulfan and antithymocte globulin. Acute GVHD developed in 57% of all patients. Relapse or disease progression developed in 42.7% of evaluable patients. The overall survival rate was 54.6%, and 80% of low risk patients were alive at the time of analysis.
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